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Speaking up in the NHS varies widely – use your new guardian to find a voice

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Today I am publishing the first annual report about the work of my national office, which was set up to improve the way NHS staff raise concerns.

dr henrietta hughes national guardian for the nhs

dr henrietta hughes national guardian for the nhs

Dr Henrietta Hughes

I am also releasing my first case review report of a specific organisation, which looks at how Southport and Ormskirk NHS Trust can improve the way it listens to staff who speak up.

Both will be presented to the Care Quality Commission, NHS England and NHS Improvement boards. The reports will show that while some improvements have been made, wide variation still exists across the NHS – and that we are on a journey.

After the Mid Staffordshire NHS Foundation Trust public inquiry, Sir Robert Francis recommended that every trust should have a freedom to speak up guardian, with a national guardian to support speaking up across the NHS.

I started in post in October last year and while we have made good progress, there is still much to do. Every trust in England now has a guardian, thousands of staff have raised concerns - including over 1,000 relating to patient safety - and guardians have received positive feedback.

“Every trust in England now has a guardian, thousands of staff have raised concerns and guardians have received positive feedback”

Our annual report highlights that guardians have a wide range of professional backgrounds, however, staff from black and minority ethnic backgrounds are under-represented and trusts need to do more to address this.

Nurses are the largest group of guardians and the largest group of staff that have spoken up. This matters because you, and those you work with on the frontline, hold the solutions to the problems in the NHS. Speaking up allows these to be implemented.

We work with guardians to develop vibrant regional networks to share best practice and provide support and buddying. We bring guardians together for training and to build links across professional and geographical barriers.

“Nurses are the largest group of guardians and the largest group of staff that have spoken up. This matters because you…hold the solutions to the problems in the NHS”

We are increasingly working with private sector providers and are helping NHS England to bring the same standards into primary care in England. We have worked with the CQC to include speaking up in the leadership element of its assessment framework, and with many other bodies whose actions set the NHS culture.

My office is now publishing data on speaking up, allowing us to monitor this on a trust-by-trust basis, plus our first ever case review report.

Cases are referred to my office when a trust’s response to concerns raised by its workers is not in accordance with good practice. If you have a concern that you would like us to review you can refer a case for consideration.

The first case review was for Southport and Ormskirk NHS Trust. We found evidence that workers were not supported to speak up, concerns were not taken seriously and there was a bullying culture. The report makes 23 recommendations including one recommendation for the CQC.

But how much impact is all of this work having?

“The quality of the leadership is undoubtedly key in fostering an open and transparent culture”

We conducted a survey of all guardians earlier this year and 60% of those who responded “agreed” or “strongly agreed” that they were making a difference - which is amazing at such an early stage.

Meanwhile, 35% of guardians did not feel that they could answer the question because they were so new in post. But worryingly 5% of guardians don’t feel they are making a difference, and we will be working to understand the reasons why.

We know that guardians in trusts rated as “outstanding” by the CQC feel more supported and that there are fewer barriers to speaking up in their organisations. The quality of the leadership is undoubtedly key in fostering an open and transparent culture.

“My call to you is to speak to your freedom to speak up guardian if you have concerns and can’t approach your line manager”

As a GP I understand the pressures in the system and things that can get in the way of delivering great care. I also understand that there can be barriers to raising your concerns.

My call to you is to speak to your freedom to speak up guardian if you have concerns and can’t approach your line manager. You can find their details here.

The right actions will be taken as a result and you will get feedback.

Dr Henrietta Hughes, national guardian for the NHS

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